Multiple drugs
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Multiple drugs Cardiac arrest, elevated glucose and lack of efficacy: case report
A 22-year-old man developed cardiac arrest following administration of fentanyl, propofol and lidocaine for general anaesthesia and elevated glucose following treatment with epinephrine for resuscitation. Additionally, he exhibited lack of efficacy following subsequent glycopyrrolate treatment for bradycardia in cardiac arrest and lidocaine bolus treatment for wide complex rhythm [routes not stated]. The man had undergone two femtosecond laser enabled keratoplasty (FLEK) at the age of 17 in the left eye and at the age of 22 in the right eye for keratoconus. Both surgeries were performed under general anaesthesia. First surgery was uncomplicated; however, 4 months following the second FLEK in the right eye, he experienced a rejection episode which was treated with topical prednisolone acetate [Pred forte] and was then switched to topical difluprednate [durezol]. The rejection episode resolved, but due to graft failure and visually significant corneal oedema, a repeat (third) right FLEK was planned. Prior to surgery, the ECG revealed a normal sinus rhythm, he was pre-retreated with midazolam and was moved to the operating theatre. He was then administered with general anaesthesia with fentanyl 25µg, lidocaine 100mg and propofol 150mg using an laryngeal mask airway (LMA). During the procedure, his HR became bradycardic, dropping from the 110’s to the 20’s. The surgery was soon paused, and glycopyrrolate 1mg was given without any response for bradycardia. He subsequently became asystolic (developed cardiac arrest) without a pulse. Soon acute cardiac life support was initiated and chest compressions were started immediately. The man received epinephrine 1mg during resuscitation process. Approximately 1 min after bradycardia was noted, he had return of a spontaneous HR with sinus tachycardia and a palpable pulse. Three minutes later, the ECG revealed a wide complex rhythm in the 80’s. Then, a bolus of lidocaine 100mg was administered without any response, followed by amiodarone, which led to resolution of the wide complex rhythm and return of sinus tachycardia. Subsequently, electrolyte abnormalities were noted along with glucose elevation. He became hypotensive and was treated with phenylephrine with improvement in blood pressure. Soon, after the completion of remaining surgery, he was extubated. He was transferred to an another hospital and was discharged 5 days later, as his cardiac work-up was negative and electrolyte abnormalities had resolved. Jarstad A, et al. Cardiac arrest during cornea transplant surgery. BMJ Case Reports 13: No. 8, 26 Aug 2020. Available from: URL: http://doi.org/10.1136/ bcr-2020-235272
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Reactions 17 Oct 2020 No. 1826
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